PAIN ASSESSMENT AND MANAGEMENT IN SICKLE CELL DISEASE

该提案将对以下项目进行全面前瞻性评估 非裔美国人血管闭塞性疼痛体验的特点 儿童和青少年镰状细胞病(SCD)的检测 导致对止痛治疗反应不佳的因素。我们的 假设对止痛治疗的不良临床反应是一种 包括潜在贡献的多因素活动 疼痛体验的特征(疼痛强度)，来自 药物治疗(改变药物清除度、生物利用度或改变 剂量-反应关系)，并从患者的心理 属性。此外，我们还将研究导致 我们认为有必要利用以医院为基础的服务 SCD患者和家属用于治疗疼痛发作。我们的 假设这种行为可以通过修改后的压力来预测- 心理调适模型。这些研究是更大计划的一部分 即确定SCD的缺氧率和病因及其 与血管闭塞性疼痛的关系，并探讨其作用 脂氧合酶代谢产物介导低氧对血管内皮细胞的影响 内皮细胞与红细胞的相互作用。 这项提案将是第一项专门描述 门诊和住院治疗的疼痛发作的疼痛强度 在大量儿童和儿童中进行前瞻性设计 患有SCD的青少年。更重要的是，这项研究将考察几个 这些患者疼痛体验的其他方面还没有 以前对此进行了深入的研究。我们将进行第一次详细研究 静脉和口服吗啡、可待因在人体内的药代动力学 SCD患者。我们还将对其药效学进行研究。 静脉注射吗啡的剂量-反应关系 对二氧化碳的通气性反应，以及PCA介导的镇痛。最后，我们会 检查患者的心理和心理社会属性 体验痛苦的经历，并描述那些预测的因素 心理调整、报告的疼痛严重程度或医院服务 利用率。 虽然这些研究中的每一项都可以单独完成，但 在同一患者群体中进行的这些研究的组合，在 在预期的基础上，将产生丰富的比较信息 将使我们能够评估一套全面的 预测止痛药临床疗效的生物心理社会因素 治疗最频繁和最令人虚弱的疼痛发作 SCD的并发症。有了这些知识，我们将能够更好地 减轻这些患者的痛苦和痛苦，改善他们的生活质量 生活质量，直到明确的抗病治疗成为 我们对患有SCD的儿童和青少年的常规临床实践。

This proposal will perform a comprehensive prospective assessment of the characteristics of the vaso-occlusive pain experience in African-American children and adolescents with Sickle Cell Disease (SCD) to determine the factors that contribute to a poor response to analgesic therapy. Our hypothesis is that poor clinical responses to analgesic therapy are a multi-factorial event that include potential contributions from characteristics of the pain experience (pain intensity), from the pharmacologic therapy (altered drug clearance, bioavailability, or altered dose-response relationship), and from the patient's psychological attributes. In addition, we will also examine factors that contribute to the perceived necessity for utilization of hospital-based services by our patients and families with SCD for treatment of painful episodes. Our hypothesis is that this behavior can be predicted by a modified stress- psychological adjustment model. These studies are part of larger program that is determining the prevalence and etiology of hypoxia in SCD and its relationship with vaso-occlusive pain, and examining the role of lipoxygenase metabolites in mediating the effects of hypoxia on endothelial cell - red cell interactions. This proposal will be the first study to specifically characterize the pain intensity of both outpatient and hospital-treated painful episodes with a prospective design in a large population of children and adolescents with SCD. More importantly, this study will examine several other facets of the pain experience in these patients that have not been previously studied in any depth. We will conduct the first detailed study of the pharmacokinetiCs of intravenous and oral morphine and codeine in patients with SCD. We will also conduct a study of the pharmacodynamics of intravenous morphine by characterizing the dose response relationship for ventilatory response to CO2 , and PCA-mediated analgesia. Finally, we will examine the psychological and psychosocial attributes of patients who experience painful episodes, and characterize those factors that predict psychological adjustment, reported pain severity, or hospital service utilization. While each one of these studies could be done in isolation, the combination of these studies in the same patient population, on a prospective basis, will yield a wealth of comparative information that will allow us to assess the relative importance of a comprehensive set of biopsychosocial factors which predict clinical response to analgesic therapy for painful episodes, the most frequent and debilitating complication of SCD. With this knowledge, we will be better able to alleviate the pain and suffering of these patients, and improve their quality of life until definitive anti-sickling therapy becomes a part of our routine clinical practice for children and adolescents with SCD.